Feasibility, acceptability and efficacy of a nurse-led palliative care health coaching intervention (Educate, Nurture, Advise before Life Ends) for patients with heart failure and their caregivers in Singapore: a randomised wait-list controlled pilot study of health coaching in Asian heart failure.

TL;DR

A culturally adapted palliative care health coaching program (ENABLE) improved heart failure patients' quality of life by a modest margin and reduced anxiety and depression in both patients and caregivers over 6 months.

What the Study Found

Heart failure affects millions globally and demands ongoing management to maintain quality of life. This randomized pilot study tested whether integrating early palliative care through structured health coaching could help patients with advanced heart failure (Stage C or D) and their caregivers manage both physical and emotional burdens. The ENABLE program, which originated in the UK and was culturally adapted for Singapore, combined a comprehensive palliative care assessment by a physician and nurse with a series of nurse-led coaching sessions designed to address disease management, symptom control, and emotional wellbeing for both patients and family caregivers.

The study recruited 48 heart failure patients and their 44 family caregivers between February 2022 and October 2023. While the program's completion rates were strong—91.7% of patients and 97.7% of caregivers finished the health coaching component—only 36.6% of approached dyads consented to participate, suggesting recruitment challenges in integrating palliative care messaging into traditional cardiac settings. Both patients and caregivers reported high satisfaction with the program, with 85-100% reporting satisfaction scores above the study's acceptability threshold. These acceptance metrics are noteworthy given that palliative care discussions around advanced heart failure remain culturally sensitive in many Asian contexts.

On efficacy measures, intervention-arm patients showed a 12.4-point improvement in disease-specific quality of life (measured by the Kansas City Cardiomyopathy Questionnaire total score) compared to the wait-list control group at 6 months, with a Cohen's d effect size of 0.43. This exceeds the study's predetermined efficacy target of 0.25 SD but represents a modest clinical improvement. Caregiver quality of life did not differ between groups, though both patients and caregivers across all arms showed sustained improvements in depression and spirituality measures at 6 months, and anxiety improvements at the 3-month mark. The researchers note these improvements in mood and spiritual wellbeing occurred in both intervention and control groups, suggesting either the assessment process itself was therapeutic or that time and supportive contact contributed to benefits.

What This Means for You

If you or a loved one is managing advanced heart failure, this study provides evidence that structured conversations with healthcare providers specifically trained in both cardiology and palliative care can meaningfully support quality of life. The emphasis on family caregiver involvement is particularly relevant, as caregivers reported high satisfaction and experienced improvements in depression and anxiety, even when formal caregiver quality-of-life metrics did not show statistical differences. The integration of early palliative care into cardiac management (rather than reserving it for end-of-life situations) aligns with growing clinical consensus that symptom management and advance planning benefit from specialist input earlier in disease progression.

Practically, if your healthcare system offers similar programs, the high completion rates suggest these interventions are acceptable and feasible to participate in. The recruitment challenge noted in the study underscores that many eligible patients may need explicit invitations and education about what palliative care actually involves to overcome misconceptions. The improvements in depression, anxiety, and spiritual wellbeing across both groups point to the importance of regular supportive contact itself, whether through a formal program or other structured touchpoints with your care team.

The modest effect size on quality of life scores warrants realistic expectations. A 12-point improvement on the KCCQ (scored 0-100) is meaningful but not transformative; heart failure management still requires consistent medication adherence, symptom monitoring, and medical appointments. However, the consistency of mental health and spiritual improvements suggests the psychological and existential dimensions of living with advanced disease are addressable through coaching, which is often overlooked in strictly pharmacological approaches.

Study Details

Sources

Primary source:

Full study on PubMed (ID: 42152453)

Study registration:

ClinicalTrials.gov NCT05211882

The authors note this is a pilot study designed to test feasibility and generate preliminary efficacy data, with phase III testing planned. The modest sample size, single-center setting in Singapore, and wait-list control design (rather than a comparison to standard care) limit generalizability, but the completion rates and satisfaction metrics provide reasonable justification for larger trials.